The effect of some more stringent PT - thoughts please
Posted , 9 users are following.
Opinions welcome please. If you'e read any of my other posts you will have got the general picture that I am 10 weeks into TKR, have had little pain, can walk quite well but have limited range of movement most probably because i didn't have more than 90deg for 20 years or so (age 66 now).
My PT up to now has been every 2-3 weeks where I have mostly just been rviewed as "!doing great" and been given exercises which I have been diligently doing. Whilst improvements all round none have made the slightest difference to my 6-90 deg other than maybe making that easier.
So at this appointment having expressed my disappointment with ROM the PT said she wasn't worried about the bend because that is easier to get later than fully straightening. So I had my first real session from the PT. She massaged my leg a fair bit and then lying on my stomach forced my knee progressively straight by pushing down with it hanging over the bed. (An exercise I have tried a bit but just with gravity). This was quite painful, especially behind the knee which she kept massaging vigourously as she pushed down. Afterwards she claimed that she had got it to zero degrees.
So the question is how would I expect to feel after this manipulation? Because the next day (today) it is the stiffest and most aching it has felt so far. It only bends readily to 85 instead of 90 and doesn't really straighten any more unless forced and is tight behind the knee.
So is what I should expect - because it doesn't seem to have done much so far or will it be freerer when it gets over the initial shock?
Thanks for any opinions, (Chico et al)
Dave
0 likes, 23 replies
Dcweather
Posted
Right - something interesting happened. Not long after this I had to have a trip to A&E with a blocked bile duct from a gall stone. (Great isn't it getting old - not a days illness since childhood mumps then a a knee replacement, AF and a blocked bile duct all in the same year!!). Ended up in hospital pretty much on my back most of the time for 8 days (go to Gall Bladder forum for more info !!)
By the end of this the following had happened:-
1. I had lost over a stone in weight (I wasn't overweight to start)
2. Any stiffness in my knee had gone
3. I could bend my knee past 90 deg for the first time with no resistance
4. Definitely straighten it more possibly almost to zero deg. Certainly enough
5. Joint feels less warm
6. Some slight muscle wastage (I've done zero exercises for two weeks)
7. Now I am walking again - slight stiffness back, maybe less bend, still straight.
So what does this all mean? Well as I am just past three months I would think it's good news. I imagine some healing still occuring but I know more ROM is at least possible and totally pain free, which it almost was, except for where this tendon joins the outside of the knee from the thigh which hsas come back a bit. It might also mean after all of the exercises for three months a good rest might be worth trying for some people.
Dave
lynn15111 Dcweather
Posted
This now proves a hunch I've had for awhile - that ROM - while you can be aggressively pushing for more, if you overdo it, you limit the improvement. I'm near 3 months post-op and my best bend is in the morning before I've stressed the knee any, and as the day goes on, it gets stiff. I saw the surgeon today and he said the national average for ROM is 110 - 115 so I guess I'm doing well and feel better that I can't fully bend to 140 or so. I thought you had to work to reach that higher degree. And I do think you want more ROM than 110 because that way when you are stiff, you have some reserve to still be able to sit comfortably. Theoretically you can improve for up to a year. And that doesn't mean to slack off, because you have to keep moving so scar tissue doesn't set in.
NZJENNI Dcweather
Posted
Ouch !!! I also have an issue with not being able to straighten my leg at 8 weeks post TKR. 10 degrees to go. Surgeon did something very similar to me and my PT was annoyed with him as in her opinion it was way too aggressive, Frikin hurt too....and the next few days was sore swollen and generally unhappy. I am doing an exercise where I put a rolled up towel under the knee with leg extended sitting on a firm surface. I try and straighten as far as I can the put a strap around the foot and pull it up straighter. This works and doesn't hurt. Apparently if I keep it up - the hard part - it will get a better degree eventually.
I look forward to hearing your progress.
Dcweather
Posted
One thing I have just thought of which may negate some of the thoughts above is that I was on pretty strong pain killers for the week including morphine and a paracetamol drip. So perhaps that accounts for the zero pain although I still think the lack of exercise and weight bearing did give the joint a chance to "calm down" and removed some of the tightness which has returned to some extent now.
lynn15111 Dcweather
Posted
The ideal is drugs and working the knee immediately and then weening off the drugs, and if you ween off too early, you can't take the workouts. Anti-inflammatories must be included as well, to calm the knee reacting by swelling. It's the level of work outs that need to be taylored to the individual and I've found most thereapists are not flexible, or willnot listen to their patients. So if an individual must separate from PT, but is not disciplined and willing to work their own knee, it's a catch 22.